Pulmonic regurgitation physical examination: Difference between revisions

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===Neck===
===Neck===
* Increased [[JVP]]
* Raised [[JVP]]<ref>{{cite book | last = Khavandi | first = Ali | title = Essential revision notes for the cardiology KBA | publisher = Oxford University Press | location = Oxford | year = 2014 | isbn = 978-0199654901 }} </ref>
* Prominent "[[a wave]]" may be present
* Prominent "[[a wave]]" may be present.
* Prominent "[[v wave]]" may be present in presence of [[tricuspid regurgitation]]
* Prominent "[[v wave]]" may be present in presence of [[tricuspid regurgitation]].


===Palpation===
===Palpation===
* [[Apical impulse]] (lift or heave) is usually present at the left lower sternal border because of [[right ventricular dilation]].
* [[Apical impulse]] (lift or heave) is usually present at the left lower sternal border because of [[right ventricular dilation]].
*[[Right ventricle|right ventricular]] heave may be present due to [[pulmonary hypertension]].<ref>{{cite book | last = Khavandi | first = Ali | title = Essential revision notes for the cardiology KBA | publisher = Oxford University Press | location = Oxford | year = 2014 | isbn = 978-0199654901 }} </ref>


===Auscultation===
===Auscultation===
====Heart Sounds====
====Heart Sounds====
* [[Pulmonic regurgitation]] is associated with wide splitting of S<sub>2</sub>.
* [[Pulmonic regurgitation]] is associated with wide splitting of S<sub>2</sub>.
* [[P2]] is accentuated because of presence of pulmonary regurgitation. In case of, absence of [[pulmonic valves]] (congenital or secondary to surgical resection), [[P2]] is inaudible.
* [[P2]] is accentuated due to [[pulmonary hypertension]]<ref>{{cite book | last = Khavandi | first = Ali | title = Essential revision notes for the cardiology KBA | publisher = Oxford University Press | location = Oxford | year = 2014 | isbn = 978-0199654901 }} </ref>.
*[[P2]] is absent/inaudible in case of, absent [[pulmonic valves]] ([[congenital]] or secondary to surgical resection).<ref>{{cite book | last = Khavandi | first = Ali | title = Essential revision notes for the cardiology KBA | publisher = Oxford University Press | location = Oxford | year = 2014 | isbn = 978-0199654901 }} </ref>
* A right-sided S<sub>3</sub> may be audible and may also be accentuated with inspiration.
* A right-sided S<sub>3</sub> may be audible and may also be accentuated with inspiration.
* Likewise, a right-sided S<sub>4</sub> may also be audible and accentuated with inspiration.
* Likewise, a right-sided S<sub>4</sub> may also be audible and accentuated with inspiration.


====Murmur====
====Murmur====
*Classically a high-pitched early-[[diastole|diastolic]] murmur is heard at [[left sternal border|left upper sternal area]].<ref>{{cite book | last = Khavandi | first = Ali | title = Essential revision notes for the cardiology KBA | publisher = Oxford University Press | location = Oxford | year = 2014 | isbn = 978-0199654901 }} </ref>
* Murmur of residual pulmonic regurgitation after [[Tetralogy of Fallot]] repair:<ref name="BousvarosDeuchar19612">{{cite journal|last1=Bousvaros|first1=GeorgeA.|last2=Deuchar|first2=DennisC.|title=THE MURMUR OF PULMONARY REGURGITATION WHICH IS NOT ASSOCIATED WITH PULMONARY HYPERTENSION|journal=The Lancet|volume=278|issue=7209|year=1961|pages=962–964|issn=01406736|doi=10.1016/S0140-6736(61)90798-X}}</ref>
* Murmur of residual pulmonic regurgitation after [[Tetralogy of Fallot]] repair:<ref name="BousvarosDeuchar19612">{{cite journal|last1=Bousvaros|first1=GeorgeA.|last2=Deuchar|first2=DennisC.|title=THE MURMUR OF PULMONARY REGURGITATION WHICH IS NOT ASSOCIATED WITH PULMONARY HYPERTENSION|journal=The Lancet|volume=278|issue=7209|year=1961|pages=962–964|issn=01406736|doi=10.1016/S0140-6736(61)90798-X}}</ref>
** It is a low-pitched and soft [[murmur]].
** It is a low-pitched and soft [[murmur]].
** Best heard along the second or third intercostal spaces adjacent to the left sternal border.
** Best heard along with the second or third intercostal spaces adjacent to the left sternal border.
** It is accentuated by squatting and inspiration.
** It is accentuated by squatting and inspiration.
** It is made softer by [[Valsalva maneuvers]] or expiration.
** It is made softer by [[Valsalva maneuvers]] or expiration.
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* [[Murmur]] of [[pulmonic regurgitation]] associated with [[pulmonary hypertension|Pulmonic hypertension]]:<ref name="pmid2662241">{{cite journal| author=Würtemberger G, Dinkel E, Joos A, Matthys H| title=[Pulmonary hypertension. Clinical picture and therapy]. | journal=Radiologe | year= 1989 | volume= 29 | issue= 6 | pages= 263-6 | pmid=2662241 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2662241  }} </ref>
* [[Murmur]] of [[pulmonic regurgitation]] associated with [[pulmonary hypertension|Pulmonic hypertension]]:<ref name="pmid2662241">{{cite journal| author=Würtemberger G, Dinkel E, Joos A, Matthys H| title=[Pulmonary hypertension. Clinical picture and therapy]. | journal=Radiologe | year= 1989 | volume= 29 | issue= 6 | pages= 263-6 | pmid=2662241 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2662241  }} </ref>
** When the [[pulmonary artery]] [[systolic pressure]] exceeds 60 mm Hg, dilatation of the [[pulmonary artery]] ring may then result in [[Graham-Steell's murmur]].
** When the [[pulmonary artery]] [[systolic pressure]] exceeds 60 mm Hg, dilatation of the [[pulmonary artery]] ring may then result in [[Graham-Steell's murmur]].
** It is a high-pitched, "blowing", early diastolic decrescendo murmur like that of [[aortic regurgitation]].
** It is a high-pitched, "blowing", early diastolic decrescendo murmurs like that of [[aortic regurgitation]].
** Best heard along the left parasternal region.
** Best heard along the left parasternal region.
** It is accentuated by inspiration.
** It is accentuated by inspiration.

Revision as of 09:31, 4 August 2020

Pulmonic regurgitation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]; Aysha Anwar, M.B.B.S[3]

Overview

Physical examination findings of pulmonary regurgitation includes increased JVP, prominent "a" wave, "v" wave in the neck. A palpable apical impulse (lift or heave) is usually present at the left lower sternal border because of right ventricular dilation. On auscultation, it may be associated with wide splitting of S2 with right sided S3 accentuated with respiration. Murmur of pulmonic regurgitation may vary depending on the underlying cause.[1][2]

Physical Examination

Neck

Palpation

Auscultation

Heart Sounds

Murmur

  • Classically a high-pitched early-diastolic murmur is heard at left upper sternal area.[7]
  • Murmur of residual pulmonic regurgitation after Tetralogy of Fallot repair:[1]
    • It is a low-pitched and soft murmur.
    • Best heard along with the second or third intercostal spaces adjacent to the left sternal border.
    • It is accentuated by squatting and inspiration.
    • It is made softer by Valsalva maneuvers or expiration.

References

  1. ↑ 1.0 1.1 Bousvaros, GeorgeA.; Deuchar, DennisC. (1961). "THE MURMUR OF PULMONARY REGURGITATION WHICH IS NOT ASSOCIATED WITH PULMONARY HYPERTENSION". The Lancet. 278 (7209): 962–964. doi:10.1016/S0140-6736(61)90798-X. ISSN 0140-6736.
  2. ↑ 2.0 2.1 Würtemberger G, Dinkel E, Joos A, Matthys H (1989). "[Pulmonary hypertension. Clinical picture and therapy]". Radiologe. 29 (6): 263–6. PMID 2662241.
  3. ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
  4. ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
  5. ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
  6. ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.
  7. ↑ Khavandi, Ali (2014). Essential revision notes for the cardiology KBA. Oxford: Oxford University Press. ISBN 978-0199654901.

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